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DrugMacrilen (macimorelin acetate granule) [Strongbridge U.S. Inc.]

April 2019

Therapeutic area - Growth Hormone Deficiency Diagnostics

Approval criteria

  • Patient must be at least 18 years of age AND
  • Patient’s body mass index (BMI) < 40kg/m2 AND
  • Macrilen is requested by an endocrinologist AND
  • Endocrinologist provides patient-specific clinical rationale for the medical necessity of Macrilen use in the diagnosis of adult growth hormone deficiency (i.e., why insulin tolerance test or glucagon stimulant test is not appropriate for a specific patient). Non patient-specific clinical rationale such as the number of blood draws, or amount of work required will not be accepted AND
  • A comprehensive review of patient’s current medication list is conducted and sufficient washout time is permitted prior to the administration of Macrilen if patient is currently taking the following medications:
    • Drugs that prolong QT interval
    • Strong CYP3A4 inducers
    • Drugs affecting growth hormone release

Quantity limits

  • 0.5mg/kg
  • Both patient’s weight (in kg) and BMI must be submitted at time of request

Billing for Macrilen

Macrilen must be billed as a medical claim.


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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